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Introdução: A dengue, uma doença viral transmitida pelo mosquito Aedes aegypti, constitui um grave problema de saúde pública em várias partes do mundo, incluindo o Brasil. No Estado de São Paulo, sua incidência apresenta flutuações significativas ao longo dos anos, marcadas por picos sazonais que representam desafios consideráveis para o sistema de saúde público. Isso se deve, em parte, à ampla gama de manifestações clínicas da infecção pelo vírus da dengue, que podem variar de leves a graves. No período entre janeiro de 2014 e abril de 2024, foram notificados inúmeros casos, destacando a necessidade de uma análise minuciosa para compreender os padrões de ocorrência e as variações anuais desses eventos. Objetivo: Compreender a distribuição mensal dos casos de dengue registrados no Estado de São Paulo de janeiro de 2014 a abril de 2024. Método: Os dados foram adquiridos através de consulta ao Departamento de Informática do Sistema Único de Saúde (DATASUS), disponível em (http://www.datasus.gov.br), utilizando a base de dados do Sistema de Informações de Agravos de Notificação (SINAN). A população de estudo incluiu todos os casos de dengue registrados no Estado de São Paulo no período de janeiro de 2014 a abril de 2024. Resultados: Durante o período de 2014 a 2024, o Estado de São Paulo registrou um total de 3.866.595 casos de dengue. Dessas ocorrências, 1.163.269 foram notificadas apenas nos primeiros quatro meses de 2024, representando 30.08% de todos os casos desde 2014. Considerando os casos no período de 2014 a 2023, os números mensais foram os seguintes: janeiro registrou 149.113 casos, fevereiro 343.722, março 629.633, abril 732.795, maio 862.367, junho 259.405, julho 86.682, agosto 41.438, setembro 29.835, outubro 33.918, novembro 45.662 e dezembro 86.095. O ano de 2014 foi especialmente alarmante, com os seguintes números: janeiro registrou 50.172 casos, fevereiro 174.775, março 419.304 e abril 494.683. Os dados foram analisados utilizando o software IBM SPSS STATISTICS 20. Para verificar a normalidade dos dados, aplicaram-se os testes de Shapiro-Wilk e Kolmogorov-Smirnov, ambos indicando uma distribuição normal. Para analisar a diferença entre os grupos, empregou-se o teste de ANOVA de medidas repetidas de um fator, com um valor p estatisticamente significante de p: 0,001. Conclusão: Durante o período de janeiro a abril de 2014, o estado de São Paulo registrou os maiores números de infecções desde o início da série histórica em 2014 para o mesmo período de meses.

Introdução: A dengue é uma arbovirose causada pela picada da fêmea do mosquito Aedes aegypti, comum em regiões tropicais do planeta, como o Brasil. Essa enfermidade tem seu risco de contágio elevado quando o ambiente se torna propício para a reprodução do vetor, caracterizado pela presença de água parada. A doença apresenta uma alta taxa de incidência e pode levar a complicações graves, incluindo a dengue hemorrágica e a síndrome do choque da dengue (SCD), que frequentemente resultam em hospitalizações. No Brasil, a saúde pública desempenha um papel crucial na gestão e tratamento dos casos de dengue, oferecendo atendimento desde a atenção básica até os serviços hospitalares de alta complexidade. Objetivo: Analisar o panorama das hospitalizações por dengue nas cinco regiões brasileiras entre 2014 e 2024. Método: Os dados foram obtidos por meio de consulta ao Departamento de Informática do Sistema Único de Saúde (DATASUS), no endereço eletrônico (http://www.datasus.gov.br), na base de dados do Sistema de Informações de Agravos de Notificação (SINAN). A população do estudo foi constituída por todos os casos de dengue no Brasil, de 2014 a 2024, que resultaram em hospitalização. Resultados: O Brasil apresentou 14.901.970 casos de dengue do ano de 2014 até 10 de maio de 2024. Desses, 450.391 resultaram em internações. Na região Centro-Oeste, o Distrito Federal teve 25.101 internações, Goiás 56.571, Mato Grosso 14.103 e Mato Grosso do Sul 12.398. Na região Nordeste, Alagoas registrou 4.841 internações, Bahia 23.224, Ceará 11.581, Maranhão 9.561, Paraíba 6.441, Pernambuco 8.094, Piauí 5.891, Rio Grande do Norte 5.119 e Sergipe 3.208. Na região Norte, Acre teve 2.861 internações, Amapá 815, Amazonas 2.385, Pará 5.045, Rondônia 3.762, Roraima 372 e Tocantins 4.194. Na região Sudeste, Espírito Santo registrou 8.037 internações, Minas Gerais 61.414, Rio de Janeiro 14.706 e São Paulo 91.974. Na região Sul, Paraná teve 45.274 internações, Santa Catarina 13.146 e Rio Grande do Sul 10.298. Conclusão: A região Sudeste, seguida pela região Centro-Oeste, apresentou, de 2014 a maio de 2024, o maior número de internações decorrentes da dengue.

Introdução: A sífilis gestacional é uma infecção ocasionada pela bactéria Treponema pallidum, transmitida da mãe para o feto durante a gravidez, podendo causar complicações graves. Enquanto isso, a COVID-19, uma doença respiratória causada pelo coronavírus SARS-CoV-2, tem impactado a saúde global desde março de 2020. No ABC Paulista, região composta pelos municípios de Santo André, São Bernardo do Campo, São Caetano do Sul, Diadema, Mauá, Ribeirão Pires e Rio Grande da Serra, tanto a sífilis gestacional quanto a COVID-19 representam desafios significativos socioeconômicos e serão analisadas sob aspectos epidemiológicos neste estudo. Objetivo: Compreender os casos diagnosticados de sífilis gestacional nos municípios do ABC Paulista, no período de 2007 a 2023, diferenciando os períodos antes e durante a pandemia de COVID-19. Método: Os dados foram obtidos por meio de consulta ao Departamento de Informática do Sistema Único de Saúde (DATASUS), no endereço eletrônico (http://www.data-sus.gov.br) na base de dados do Sistema de Informações de Agravos de Notificação (SINAN). A população do estudo foi constituída por todos os casos de sífilis gestacional nos anos de 2007 a 2023 dos municípios da região do ABC de São Paulo, que são: Diadema, Mauá, Ribeirão Pires, Rio Grande da Serra, Santo André, São Bernardo do Campo e São Caetano do Sul, também conhecida como ABC. Resultados: No período de 2007 a 2019 (pré-pandemia), foram registrados em média 34,40 casos, enquanto de 2020 a 2023 (durante a pandemia), a média foi de 96,89 casos. Os dados foram analisados utilizando o software IBM SPSS Statistics 20. Para testar a normalidade dos dados, foram aplicados os testes de Shapiro-Wilk e Kolmogorov-Smirnov, os quais indicaram uma distribuição não normal. Para analisar a diferença entre os grupos, foi utilizado o teste de Mann-Whitney, que apresentou um valor de p igual a 0,001. Conclusão: Os municípios da região do ABC de São Paulo, que são Diadema, Mauá, Ribeirão Pires, Rio Grande da Serra, Santo André, São Bernardo do Campo e São Caetano do Sul, apresentaram um aumento nos casos de sífilis gestacional durante a pandemia de COVID-19.

Introdução: Durante os anos de 2020 a 2023, o panorama mundial enfrentou a pandemia de COVID-19, causada pelo vírus SARS-CoV-2. Neste contexto, este trabalho analisará os casos de sífilis gestacional, uma Infecção Sexualmente Transmissível (IST) causada pela bactéria Treponema pallidum. Essa doença pode ser transmitida ao feto pela placenta materna quando a mãe está infectada, seja ela sintomática ou não. Objetivo: Compreender os casos diagnosticados de sífilis gestacional na cidade de São Paulo no período de 2007 a 2023, diferenciando os períodos antes e durante a pandemia de coronavírus (COVID-19). Método: Os dados foram obtidos por meio de consulta ao Departamento de Informática do Sistema Único de Saúde (DATASUS), no endereço eletrônico http://www.datasus.gov.br, na base de dados do Sistema de Informações de Agravos de Notificação (SINAN). A população do estudo foi constituída por todos os casos de sífilis gestacional registrados entre os anos de 2007 e 2023 na cidade de São Paulo. Resultados: No período de 2007 a 2019 (pré-pandemia), foram registrados, em média, 2425 casos, e de 2020 a 2023 (durante a pandemia), foram registrados, em média, 5684 casos. Os dados foram analisados pelo software IBM SPSS Statistics 20. Para testar a normalidade dos dados, foram aplicados os testes de Shapiro-Wilk e Kolmogorov-Smirnov, que indicaram distribuição normal. Para analisar a diferença entre os grupos, foi aplicado o teste t para amostras independentes, o qual resultou em um valor de p de 0,004. Conclusão: Durante a pandemia de COVID-19, a cidade de São Paulo registrou um aumento nos casos de sífilis gestacional.

Abstract Background Mechanical augmentation upon implantation is essential for the long‐term success of tissue‐engineered intervertebral discs (TE‐IVDs). Previous studies utilized stiffer materials to fabricate TE‐IVD support structures. However, these materials undergo various failure modes in the mechanically challenging IVD microenvironment. FlexiFil (FPLA) is an elastomeric 3D printing filament that is amenable to the fabrication of support structures. However, no present study has evaluated the efficacy of a flexible support material to preserve disc height and support the formation of hydrated tissues in a large animal model. Methods We leveraged results from our previously developed FE model of the minipig spine to design and test TE‐IVD support cages comprised of FPLA and PLA. Specifically, we performed indentation to assess implant mechanical response and scanning electron microscopy to visualize microscale damage. We then implanted FPLA and PLA support cages for 6 weeks in the minipig cervical spine and monitored disc height via weekly x‐rays. TE‐IVDs cultured in FPLA were also implanted for 6 weeks with weekly x‐rays and terminal T2 MRIs to quantify tissue hydration at study endpoint. Results Results demonstrated that FPLA cages withstood nearly twice the deformation of PLA without detrimental changes in mechanical performance and minimal damage. In vivo, FPLA cages and stably implanted TE‐IVDs restored native disc height and supported the formation of hydrated tissues in the minipig spine. Displaced TE‐IVDs yielded disc heights that were superior to PLA or discectomy‐treated levels. Conclusions FPLA holds great promise as a flexible and bioresorbable material for enhancing the long‐term success of TE‐IVD implants.

Objectives: As the COVID-19 pandemic continues to be an issue worldwide, the foregoing phenomena are especially problematic for those in community health and rural clinics with limited funding available; such providers markedly reported that the pandemic negatively impacted their quality of life (QOL). Hence, the aim of this study was to determine the psychological impact of the COVID-19 pandemic on primary health-care providers at a primary care clinic. In addition, the research gathered information about respondents’ characteristics vis-à-vis the work-related psychological impact among providers. Subjects and Methods: A self-administered questionnaire was mailed to 62 primary health-care providers at a Primary Care Clinic in North Texas, with a 69% response rate (n = 43). In addition to descriptive statistics, multiple logistic regression was conducted to determine characteristics related to the presence of work-related psychological impact among providers. Results: Results revealed that the main psychological manifestations perceived by providers were work-related stress (77%), depression (51%), and anxiety (40%). In addition, the results showed that those subspecialists and chiropractors were less likely to report that the pandemic negatively impacted their QOL because they have previous exposure to similar traumatic events. Conclusion: The pandemic has led to relatively higher levels of psychological impact among primary health-care providers and chiropractic professionals at the clinic. The findings suggested that it is necessary to offer providers the necessary support to reduce the psychological impact derived from the pandemic. Future studies should include providers from diverse geographic locations in their sample for a better understanding of this phenomenon.

Abstract Lightweight mortars are indicated for services that require low specific mass composites. There are several lightweight aggregates available on the market. Waste rubber from tires is a low-density waste option that can be used as lightweight aggregate. The rubber waste when used in mortar reduces its density, in addition to bringing benefits from an environmental point of view. In this research, the mechanical behavior, and physical properties of mortars in which the natural fine aggregate contents were replaced by mixtures in different proportions of rubber, expanded vermiculite, and expanded clay were investigated. For the analysis of the properties of the composites, they were submitted to tests of dynamic modulus of elasticity, damping, compressive strength, flexural strength, coefficient of capillarity, density, and determination of ultrasonic wave transmission velocity. All tested mortars met the requirements of the Brazilian standard, being indicated for laying and covering walls and ceilings, in addition to having excellent acoustic and damping performance.

Abstract The hippocampus is pivotal in integrating emotional processing, learning, memory, and reward-related behaviors. The dorsal hippocampus (dHPC) is particularly crucial for episodic, spatial, and associative memory, and has been shown to be necessary for context- and cue-associated reward behaviors. The nucleus accumbens (NAc), a central structure in the mesolimbic reward pathway, integrates the salience of aversive and rewarding stimuli. Despite extensive research on dHPC→NAc direct projections, their sufficiency in driving reinforcement and reward-related behavior remains to be determined. Our study establishes that activating excitatory neurons in the dHPC is sufficient to induce reinforcing behaviors through its direct projections to the dorso-medial subregion of the NAc shell (dmNAcSh). Notably, dynorphin-containing neurons specifically contribute to dHPC-driven reinforcing behavior, even though both dmNAcSh dynorphin- and enkephalin-containing neurons are activated with dHPC stimulation. Our findings unveil a pathway governing reinforcement, advancing our understanding of the hippocampal circuity’s role in reward-seeking behaviors.

The decade from 2010–2020 has seen the development of cone beam weight-bearing CT (WBCT) as a major innovation in the foot and ankle realm, becoming an important modality for bone and joint imaging. The ability to provide three-dimensional images of the naturally loaded skeleton has enabled several subsequent innovations to arise with aims to hasten image processing and to extend the clinical applications of WBCT. The objective of this work was to identify, categorize and explain those emerging techniques. We performed a structured review of the literature according to PRISMA standards, finally including 50 studies. We subsequently proposed a classification of these techniques. Segmentation and distance mapping were identified as key features. We conclude that although WBCT has already been adopted in a number of clinical communities with an immediate improvement in patient workflows, adoption of advanced techniques is yet to come. However, that relies mostly not on the technology itself, but on improvements in AI software allowing practitioners to quickly process images in daily practice and enabling the clinicians to obtain an accurate three-dimensional evaluation of the segment considered. Standardization will be paramount to amass large amounts of comparable data, which will fuel further innovations in a potentially virtuous circle.

The inadequate disposal of waste tires has caused environmental and public health problems. One of the direct harmful effects is the noise due to traffic. Waste rubber has been used in concrete to improve its acoustic performance and energy absorption. Studies carried out by the U. S. Federal Highway Administration show that barriers, regardless the material used, do not block completely but can reduce the volume of traffic noise by half. This study proposes concrete mixes containing waste tires and vermiculite to verify their acoustic properties for road barriers. The experiments include concrete with waste tires and vermiculite to replace the sand mass from 10% to 40%. An improvement in the acoustic properties was observed, reducing the total sound intensity level of the concrete acoustic barrier to 20 dB and 29 dB, for the frequencies of 500 Hz and 1000 Hz, respectively.

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: It has become a reality with the advent of weight bearing CT (WBCT) that weight bearing (WB) is a significant element to be considered when analyzing foot and ankle images. Some knowledge has begun to accumulate on the effect of WB on bone positioning, but the effect of WB on bone mineral density (BMD) distribution, apart from being a long for accepted truth since the works of Julius Wolff, could not until now be visualized other than on the biological level. Now, Hounsfield Units allow for bone density analysis on WBCT. The objective of the study was to compare the relative positions of the geometric foot center (GC) and the density-weighted foot center (DC). We hypothesized those to be different. Methods: Ethics approval was obtained. Thrity two feet from our WBCT database were retrospectively randomly selected (Curvebeam Pedcat, Hatfield PA, USA). Datasets were analyzed using Bonelogics software (Disior, Paragon 28, USA). Bone segmentation was performed to obtain all bone orientations and volumes excluding tibia and fibula and all phalanges. The data was computed to obtain the geometric centers (from bone surface coordinates), which were considered as reference and were given a value of 0. Therefore density-weighted centers (from all bone data including density) were calculated. The difference between the two centers represented the shift which was assessed along the sagittal axis (anterior shift), transversal axis (lateral shift) and craniocaudal axis (upward shift). Statistical analysis was conducted using STATA package. Results: The mean age and Body Mass Index of the cohort were 57.2 ± 9.6 years and 22.2 ± 2.8 kg/m 2 , respectively. The 3D displacement vector between GC and DC had a norm of 10.01 mm. We found that DC was significantly shifted anteriorly by 8.9 ± 0.3 mm (range, 5.6 mm to 13.4 mm), medially by 0.4 ± 0.8 mm (range, -1.3 mm to 0.3 mm) and upwardly by 4.2 ± 0.14 mm (range, 2.8 mm to 5.9 mm) (p < 0.001 in all cases). Conclusion: Our hypothesis was confirmed: the geometric and weighed foot centers were different. DC was more anteriorly and slightly medially situated. Both centers were situated at the interface between the talus and cuboid. The more anterior position may be explained by the fact that human foot is responsible for anteriorly orientated longitudinal movement on average. We deem that BMD is a significant dimension in WBCT datasets that cannot be ignored in the development of new measurement tools that are not currently standardized. Alignment based purely on bone outer shape without considering BMD may not be representative of their true biomechanical state.

Abstract Background Tissue‐engineered intervertebral disc (TE‐IVD) constructs are an attractive therapy for treating degenerative disc disease and have previously been investigated in vivo in both large and small animal models. The mechanical environment of the spine is notably challenging, in part due to its complex anatomy, and implants may require additional mechanical support to avoid failure in the early stages of implantation. As such, the design of suitable support implants requires rigorous validation. Methods We created a FE model to simulate the behavior of the IVD cages under compression specific to the anatomy of the porcine cervical spine, validated the FE model using an animal model, and predicted the effects of implant location and vertebral angle of the motion segment on implant behavior. Specifically, we tested anatomical positioning of the superior vertebra and placement of the implant. We analyzed corresponding stress and strain distributions. Results Results demonstrated that the anatomical geometry of the porcine cervical spine led to concentrated stress and strain on the posterior side of the cage. This stress concentration was associated with the location of failure of the cages reported in vivo, despite superior mechanical properties of the implant. Furthermore, placement of the cage was found to have profound effects on migration, while the angle of the superior vertebra affected stress concentration of the cage. Conclusions This model can be utilized both to inform surgical procedures and provide insight on future cage designs and can be adopted to models without the use of in vivo animal models.

Category: Hindfoot; Arthroscopy Introduction/Purpose: Supramalleolar osteotomies have been proposed as surgical option to realign the ankle joint in case of altered intra-articular loading. Little is known about the changes occurring at the tibiotalar joint after inframalleolar procedures, such as the corrective arthroscopic anterolateral subtalar arthrodesis (ALAPSTA). We set out to investigate changes in terms of joint interaction between the articular surfaces at the tibiotalar joint after corrective anterolateral arthroscopic subtalar arthrodesis (ALAPSTA) to treat Progressive Collapsing Foot Deformity (PCFD) with sinus tarsi impingement and subtalar joint degeneration. We hypothesized that ALAPSTA would improve hindfoot malalignment and that the distances between articular surfaces at the ankle would change significantly. Methods: In this retrospective study, we evaluated a consecutive series of 33 feet from 33 patients (mean age 60 years, SD 16.2; 16 right and 17 left) diagnosed with PCFD undergone ALAPSTA and reassessed at a mean follow-up of 7 months (range, 2 to 50). Weightbearing computed-tomography (WBCT) images were retrieved and the Foot and Ankle Offset (FAO) was calculated to assess the hindfoot alignment. Distance Mapping (DM) at the ankle joint (divided in 9 regions) allowed to assess changes in terms of joint interaction at this level between pre and postoperative images. Results: Hindfoot alignment significantly improved with a pre-operative FAO at 10.7 points (SD 4.7) and a post-operative FAO at 4.8 (SD 4.9) (p < 0.001). The mean improvement was 5.6 points. We found a significant increase in mean distances occurring posterolaterally at the ankle (from 4.5 mm (SD 1.2) to 5.4 mm (SD 1.5), p< 0.001) along with a significant decrease occurring anteromedially (from 9.1 mm (SD 1.2) to 8.3 mm (SD 1.4), p< 0.001). Conclusion: In this series, ALAPSTA was effective at correcting hindfoot malalignment in PCFD. After the procedure, the interaction at the ankle joint significantly changed with a reduction of anteromedial distance and an increase of posterolateral distance. Inframalleolar procedures seem to alter significantly the interaction between the tibia and the talus at the ankle. Further studies are warranted to ascertain whether changes in distances between surfaces correspond to changes in intra-articular pressures.

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: Weight-bearing CT (WBCT) enables accurate 3D hindfoot alignment (HA) measurements such as the Foot Ankle Offset (FAO). However, this uses anatomical landmarks and oversimplifies anatomy. Stress distribution influences bone mineral density (BMD). Hounsfield units (HU) are the tomographic measurement unit for BMD. We aim to analyze the distribution of BMD in the foot bones, relative to the long axis of the second metatarsal (M2), an accepted landmark for foot orientation, and its correlation with HA. Methods: In this retrospective study, 81 feet (27 per HA group : normal, valgus or varus) were included from our database after ethics approval. After 3D segmentation, a HU-weighted map (HUM) of the foot was projected on the ground plane with orientation defined by the longitudinal axis of the 2nd metatarsal. A HU Curve (HUC) was drawn, corresponding to the center of mass of the HUM in the coronal plane. We studied the HU angle (HUA) formed by HU Line (HUL) (linear regression of the HUC) and M2 longitudinal axis. Results: The groups were comparable by age, sex and BMI. A positive correlation between FAO and HU angle was found (r =0.75, p< 0.001). HUA were -0.4° ± 5.5° in varus, 3.5° ± 6.8° in normals, 13.4° ± 5.1° in valgus (F=39.7 and p< 0.001). HUA differences were significant between normals and varus (p < 0.05), and between normals and valgus (p < 0.001). FAO and HUA were significantly correlated in valgus (rho=0.437, p=0.002) and varus (rho=0.540, p=0.004). Conclusion: We found altered distributions in misaligned cases, and BMD was correlated with HA. The HUL could be an interesting new tool to analyse the topography of bone distribution in WBCT.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The outcomes of Hallux Valgus (HV) surgical treatment are perfectible. First ray dysmorphia in HV appears to incorporate a first metatarsal (M1) hyperpronation and a valgus deviation of M1 distal articular surface. Those could play a role in first ray destabilization and misalignment in HV. However, we do not know whether correction of these deformities could improve HV surgical treatment outcomes. Therefore, we performed a study to assess the impact of M1 distal supination osteotomy, M1 distal varization osteotomy, and combination of both on HV clinical and radiological outcomes. We hypothesized that M1 distal supination osteotomies would improve surgical outcomes in HV. Methods: We conducted an IRB-approved multicenter randomized control trial. HV with an indication for surgical correction were included. HV requiring surgery of the lesser metatarsals were excluded. Feet were randomly divided into 4 groups corresponding to 4 different types of surgery (Figure): 1. Control, classical M1 distal chevron. 2. Supination M1 distal chevron 3. Varization M1 distal chevron 4. Combination of the latter two. Preoperative evaluation and 6-months follow-up were performed. Demographics, AOFAS score, complications, and patient satisfaction (Likert Scale) were collected. On conventional weight-bearing radiographs before and 6 months after surgery, we measured the Hallux Valgus Angle(HVA), the Intemetatarsal Angle(IMA) the Distal Metatarsal Articular Angle(DMAA), the Okuda's M1 head shape classification(from round to angular) and the sesamoid position according to Hardy and Clapham. Normality of different variables was assessed using the Shapiro-Wilk test. Groups were compared using ANOVA for normal and Kruskall Wallis for nonnormal variables. Post-hoc pairwise analyses were performed with Dunn-Bonferoni’s test. Results: 100 HV were included. 8 were lost to follow-up. The Control (n=24), Supination (n=20), Varization (n=26) and Combination (n=22) groups were comparable on age, gender, BMI, and preoperative radiological parameters. At 6 months, there was no difference on AOFAS improvement (p=0.39) and patients satisfaction (p=0.14) whereas there were significant differences on HVA (p < 0.001), IMA (p < 0.001), DMAA (p < 0.001), Okuda's classifcation (p < 0.001) and sesamoid position (p < 0.001) between groups. We found lower HVA values for Combination VS Control (p < 0.001), Combination VS Varization (p < 0.001), Supination VS Control (p < 0.001) and Supination VS Varization (p = 0.005). Asymptomatic recurrences (HVA>15°) were present in 5 cases in Control (20.8%), and 2 in Varization (7.7%). Asymptomatic Hallux Varus (HVA < 0°) were present in 4 cases in Combination (18.2%), and 1 in Supination (5%). Conclusion: Distal M1 supination osteotomies showed better improvement in radiological parameters without showing clinical benefit. The combination of supination and varization osteotomies could lead to overcorrection while the classic M1 distal chevron could lead to insufficient corrections. Routinely performing a supination osteotomy in HV surgical management may lead to erroneous correction and we recommend an à la carte treatment. These results are preliminary and we recommend more patients and longer follow-up to confirm these findings.

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high. Methods: We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value < 0.05 was considered significant. Results: Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1. Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.

In a recently published essay on planning theory, Benjamin Davy, Meike Levin-Keitel and Franziska Sielker observe a “brutal plurality of truths” that complicates spatial planning. In particular, they ask how planners can deal with this. Against the backdrop of the climate and biodiversity crisis, the commentary takes this essay as an opportunity to take a critical look at the multiplicity of truths postulated by postmodernism and the correspondingly stretched concept of knowledge. Above all, it points out the great importance of the pursuit of truth (in the singular) for society. Moreover, it emphasises the danger of making inter- and transdisciplinary research more difficult, of depreciating science and of increasing the distance between science and the centre of society. The commentary pleads for a faster, stronger focus on the very big challenges of our time, for which a pragmatic orientation towards truth and what unites society is indispensable.

Concrete structures are susceptible to several factors during their life cycles, which can cause various problems. This situation can be avoided in many cases if Structural Health Monitoring (SHM) is used. However, such monitoring is often expensive due to the large number of sensors and the use of data acquisition systems (DAQ). In this context, self-sensing cement composites (SSCCs), monitoring themselves without sensors by incorporating conductive fillers in their composition, provide a better piezoresistive effect. In this research, the Arduino platform and analog to digital converters (ADC) modules were tested, and a prototype of a low-cost DAQ was developed for monitoring SSCCs. The devices were analyzed from the compression tests on the mortar specimens, and the results were compared to measurements obtained from the reference equipment (professional DAQ). The results showed a good sensitivity and an adequate correlation between both devices in some cases. It showed that the Arduino platform has the potential to be used in the experimental monitoring of SSCCs, however it needs to be combined with an ADC module.

The use of steel fibers in concrete affects its rheological properties in the fresh state and increases its energy absorption capacity in the hardened state. Rubber fibers come from tires and when incorporated into concrete, they promote an improvement in its damping factor. This work aimed to evaluate the use of rubber fibers on the mechanical properties of concrete reinforced with steel fibers. The evaluated properties were: compressive strength, tensile strength, static and dynamic modulus of elasticity and damping. The mixes of the tested concretes varied the consumption of steel and rubber fibers. From the results found, it can be seen that the rubber associated with steel fibers within the concrete mixtures improves the damping rates of the material.

Recycled crumb rubber can be sustainable used in mortar both to mitigate nature aggregate consumption, reducing environmental pollution, as well, to improve the acoustic and thermal performance of buildings, without damaging its mechanical properties. This paper explores workability, microstructure, mechanical, thermal and acoustic properties considering increasing contents of crumb rubber (0%, 5%, 10%, 15% and 20% replacement, by volume, of fine aggregate). Mortar characterization tests were carried out in the fresh and hardened state. It has been found that replacing the aggregate with scrap tyre rubber reduced the compressive strength on average 12% and 67% and for tensile strength 35% and 53%, for the contents of 10% and 20% respectively, compared to the reference. Furthermore, it was found that the reductions in thermal conductivity reached 16% and 29% and an increase in acoustic attenuation on average 12% and 13%. Moreover, scanning electron microscopy images were analyzed, justifying the mechanical results obtained. Although the experimental results indicated that the workability and mechanical strengths decreased with the increase of rubber replacement rate, the studied mixtures met the standard specifications, and thus suitable for walls and ceilings coating applications, improve the acoustic and thermal performance of buildings and as a sustainable material.

Background:. Middle facet subluxation (MFS) has been established as an early indicator of peritalar subluxation. However, when progressive collapsing foot deformity (PCFD) affects the ankle leading to a valgus talar tilt (Class E), structures and anatomic relationships distal to the ankle joint may be affected. Therefore, this study aimed to assess radiographic parameters of peritalar subluxation in patients with PCFD who either did or did not have a valgus ankle. Our hypothesis was that these parameters would differ in Class E patients, upsetting their capability to quantify deformity. Methods:. We performed a prospective comparative study utilizing weight-bearing computed tomography (WBCT) images of 21 feet with PCFD and with valgus of the ankle and 64 with flexible PCFD without ankle involvement. Parameters including MFS, the medial cuneiform-to-floor distance, the forefoot arch angle, the talonavicular coverage angle, the hindfoot moment arm (HMA), the foot-ankle offset (FAO), and the talar tilt angle (TTA) were measured and compared. Variables that influence the presence of ankle valgus and overall alignment were assessed by multivariable regression models. Results:. Patients with PCFD and ankle valgus demonstrated a higher mean HMA (20.79 mm [95% confidence interval (CI), 17.56 to 24.02 mm] versus 8.94 mm [95% CI, 7.09 to 10.79 mm]), FAO (14.89% [95% CI, 12.51% to 17.26%] versus 6.32% [95% CI, 4.96% to 7.68%]) and TTA (95% CI, 17.10° [14.75° to 19.46°] versus 2.30° [95% CI, 0.94° to 3.65°]) and lower mean MFS (21.84% [95% CI, 15.04% to 28.63%] versus 38.45% [95% CI, 34.55% to 42.34%]) compared with the group without ankle valgus (p < 0.0001 for all). The FAO was influenced by MFS in the group without ankle valgus (p

Abstract The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.

OBJECTIVES/GOALS: We evaluated the long-term success of tissue engineered intervertebral discs (TE-IVDs) cultured in flexible (FPLA) or stiff (PLA) support materials, hypothesizing that FPLA would maintain disc height and tissue hydration in the minipig spine. METHODS/STUDY POPULATION: TE-IVD: NP cells were encapsulated in alginate and NP plugs were placed in the center of FPLA cages. AF cells were encapsulated in type I collagen and pipetted around NP plugs. Implantation: Empty FPLA cages (n=4), and TE-IVDs cultured in FPLA (n=4) were implanted at C3-4 or C5-6 following complete discectomy (DX) in skeletally mature minipigs (n=4). Imaging and Quantification: Terminal disc height indices (DHI) were calculated from weekly x-rays using a previously described method, and results were compared to the PLA pilot study. T2 MRI scans were taken of levels treated with TE-IVDs to quantify disc hydration as previously described. RESULTS/ANTICIPATED RESULTS: FPLA cages restored DHIs to native levels until endpoint. In contrast, PLA cages fractured, and terminal DHIs were statistically similar to DX levels. Of the four levels treated with TE-IVDs, 2 were displaced from the disc space. Stabilized levels yielded DHIs which were statistically similar to native IVD and greater than displaced and DX levels. Displaced levels yielded DHIs which were significantly lower than native and stabilized levels, but greater than DX levels (P